The quest for reimbursement is a mind-numbing maze for most home medical equipment providers. Dead ends, in the form of reviews and denials, abound along the path to reimbursement for HME products and services. But for most providers who are willing to play the reimbursement game, there always is a reward at the end. Earlier this year, HomeCare randomly surveyed 398 HME providers to find out what paths they take in navigating the reimbursement labyrinth. How do the following survey results compare with your tactics for navigating the money maze?

How many of your employees are involved in reimbursement-related tasks such as order intake, billing, accounts receivable and collections?

3-4 employees	26.9%
2 employees	20.1%
6-10 employees	16.8%
5 employees	11.3%
11-50 employees	8.8%
50+ employees	2.8%
No employees	1.3%
Base: 388

When your employees are taking orders, what information do they gather during the initial call or visit?

Patient name, address, phone	95.7%
Patient insurance	91.5%
Physician name	90.7%
Patient has prescription	87.9%
Patient already has same or similar equipment	75.1%
Additional contact person	72.9%
Patient interested in other products	39.9%
Other	11.8%
Base: 393

Considering all of the claims you submit, what percentage are reviewed or denied?

1% to 5%	36.2%
16% to 50%	19.6%
6% to 10%	18.1%
11% to 15%	9.0%
More than 50%	3.0%
None	1.5%
Average	13.7%
Base: 348

Which of the following best describes your company''s business?

Full-service HME provider	30.7%
Durable medical equipment only	23.4%
HME with respiratory therapy	13.1%
HME with pharmacy	9.0%
HME with rehab	6.8%
HME with infusion therapy	2.3%
Other	14.8%
Base: 398

Which of the following products and services do you offer?

Beds and support surfaces	71.9%
Aids to daily living	71.4%
Mobility/seating and positioning	66.6%
Respiratory products	60.3%
Incontinence products	53.0%
Rehab products/services	43.2%
Prosthetics/orthotics	34.9%
Respiratory therapy	27.6%
Women''s health products	16.3%
Infusion therapy	13.3%
Other	24.4%
Base: 394

How often are your reimbursement claims for the following products and services reviewed or denied?

(According to a four-point scale where 4=frequently and 1=rarely)

Product	Mean Rating
Mobility/seating and positioning	2.18
Rehab products/services	2.08
Infusion therapy	1.85
Respiratory products	1.70
Beds and support surfaces	1.67
Incontinence products	1.67
Aids to daily living	1.57
Respiratory therapy	1.57
Prosthetics/orthotics	1.53
Women''s health products	1.41
Other	2.00

To which of the following payers do you submit reimbursement claims?

Medicare	88.7%
Private pay insurer	82.7%
Medicaid	79.6%
Managed care organization	65.3%
Other	21.1%
Base: 380

What percentage of your revenue is generated from each of these payers?

Medicare	48%
Medicaid	19%
Managed care organization	14%
Private pay insurer	13%
Other	6%
Base: 334

How often are your reimbursement claims to the following payers reviewed or denied?

(According to a four-point scale where 4=frequently and 1=rarely.)

Payer Type	Mean Rating
Managed care organization	2.03
Medicare	2.01
Medicaid	1.89
Private pay insurer	1.81

What is the major reason your reimbursement claims are reviewed or denied?

Payer question about medical necessity	28.4%
Multiple reasons	20.1%
Missing information	11.3%
Inaccurate information	9.3%
Third-party payer error	7.3%
Product or service not covered by payer	5.8%
Payer question about claim code	3.0%
Other	6.5%
Base: 365

Who on your staff handles third-party payer questions, problems or claim denials?

A billing employee	56.0%
A manager or supervisor	53.0%
An accounts receivable employee	37.4%
An order intake employee	7.5%
Whoever gets the call or letter	5.5%
Other	3.8%
Base: 376

What percentage of your denials do you appeal?

Mean:	73% of denials are appealed
Appeal all denials (100%)	39.2%
76% to 99% are appealed	21.9%
1% to 10% are appealed	17.3%
11% to 50% are appealed	5.5%
51% to 75% are appealed	3.0%
None are appealed	1.8%
Base: 353

What percentage of your appeals are successful?

Mean:	69% of appeals are successful
76% to 90% are successful	29.1%
1% to 50% are successful	24.6%
51% to 75% are successful	12.3%
91% to 99% are successful	9.5%
All appeals are successful (100%)	9.5%
No appeals are successful	1.0%
Base: 343

What percentage of your revenue do the following products or services generate?

Respiratory products	25%
Mobility/seating and positioning	18%
Beds and support surfaces	10%
Rehab products/services	8%
Aids to daily living	6%
Incontinence products	6%
Prosthetics/orthotics	6%
Infusion therapy	5%
Respiratory therapy	5%
Women''s health	1%
Other	11%
Base: 316

What is your company''s overall Days Sales Outstanding?

Mean: 61 days
60-89 days	22.1%
31-59 days	20.6%
30 days or less	16.1%
90-119 days	11.1%
120 days or more	5.3%
Base: 299

If you calculate separate DSO averages by product or service, what is your average DSO on each of the following?

Beds and support surfaces	87 days
Mobility/seating and positioning	82 days
Aids to daily living	76 days
Respiratory products	72 days
Incontinence products	56 days
Rehab products/services	55 days
Prosthetics/orthotics	43 days
Respiratory therapy	38 days
Infusion therapy	28 days
Women''s health products	21 days
Other	29 days

If you calculate separate DSO averages by payer type, what is your average DSO on each of the following?

Medicare	42 days
Medicaid	38 days
Managed care organizations	36 days
Private pay insurer	33 days

What is your total revenue?

Less than $500,000	25.4%
$500,000 - $999,999	22.1%
$1.0 - $1.49 million	16.1%
$1.5 - $2.99 million	15.8%
$5 million or more	10.3%
$3 - $4.99 million	7.5%
Weighted revenue average (in millions)	$1.75%
Base: 387

Which DMERCs process your Medicare reimbursement claims?

DMERC Region A	22.4%
DMERC Region B	27.1%
DMERC Region C	43.7%
DMERC Region D	25.1%
Base: 353

How would you rate the performance of your DMERC(s) on the following?

(According to a five-point scale where 1=unacceptable and 5=excellent.)

Accurate Payment		Timely Information
Mean Ratings		Mean Ratings
DMERC Region A	3.61	DMERC Region A	3.07
Base: 85		Base: 82
DMERC Region B	3.48	DMERC Region B	3.03
Base: 31		Base: 31
DMERC Region C	3.71	DMERC Region C	3.26
Base: 28		Base: 27
DMERC Region D	3.63	DMERC Region D	2.78
Base: 19		Base: 18
Complete Information		Timely Payment
Mean Ratings		Mean Ratings
DMERC Region A	3.34	DMERC Region A	3.29
Base: 82		Base: 85
DMERC Region B	3.20	DMERC Region B	3.00
Base: 30		Base: 31
DMERC Region C	3.56	DMERC Region C	3.11
Base: 27		Base: 27
DMERC Region D	3.22	DMERC Region D	3.11
Base: 18		Base: 19
Easy Electronic Billings		Timely Reviews
Mean Ratings		Mean Ratings
DMERC Region A	3.66	DMERC Region A	2.49
Base: 80		Base: 83
DMERC Region B	3.71	DMERC Region B	2.39
Base: 31		Base: 31
DMERC Region C	3.92	DMERC Region C	2.50
Base: 25		Base: 26
DMERC Region D	3.79	DMERC Region D	2.68
Base: 19		Base: 19